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If silence speaks volumes then this year’s Autumn Statement sent a deafening message to the NHS and its partners in social care. The decision of the Chancellor of the Exchequer, Philip Hammond, not to heed widespread calls for additional funding, especially for social care, reflects an uncertain outlook for the economy after the June referendum vote to leave the EU.

Forecasts for economic growth have been revised downwards, and the timetable for eliminating the deficit in public finances has been extended. In the absence of a willingness to raise taxes, the Chancellor was left with little room for manoeuvre.

The government’s inaction came despite speculation that local authorities would be given greater freedom to raise council tax to support a social care system that the usually cautious Care Quality Commission has described as being at a 'tipping point'. Cuts in social care spending mean that 400,000 fewer older people are receiving publicly funded care than in 2009-10 as councils are forced to ration access to care. These cuts are also having a growing impact on the NHS, with increasing numbers of patients waiting to be discharged from hospital because of lack of support in the community.